For Schizophrenia, psychotic or manic symptoms of Schizoaffective disorder
Blood dyscrasias, cardiovascular disease, conditions predisposing to seizures, depression, diabetes (may raise blood glucose), epilepsy, history of jaundice, myasthenia gravis, Parkinson’s disease (may be exacerbated) (in adults); photosensitisation (may occur with higher dosages) prostatic hypertrophy (in adults) severe respiratory disease, susceptibility to angle-closure glaucoma.
Cautions – Further information
Cardiovascular Disease – An ECG may be required particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or in cases where the patient is being admitted as an inpatient.
RARE – SUDDEN DEATH – WITHDRAWAL SYNDROME NEONATAL
For all anti-psychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms)
increased risk of stroke
for use as a hypnotic, unless sleep disorder is due to psychosis or dementia – risk of confusion, hypotension, extrapyramidal side effects and falls.
for patients prone to falls (may cause gait dyspraxia, parkinsonism)
The above just some of the things listed.
Agitation, amenorrhoea, arrhythmias, constipation, dizziness, drowsiness, dry mouth, QT interval prolongation, rash, seizure tremor vomiting, weight increased, movement disorders, insomnia
Agranulocytosis, embolis, Neuroleptic malignant syndrome Sudden death withdrawal syndrome neonatal Yes I have seen Elizabeth suffer Neuroleptic Malignant Syndrome on Clozapine.
appetite abnormal, asthenia, anxiety, cardiac conduction disorders, cough, depression diarrhoea, fever, gastrointestinal discomfort, headache, hyperglycaemia, hypertension, increased risk of infection, joint disorders, laryngeal pain, mood altered, nasal congestion, nausea, oral disorders, pain, skin reactions, vision disorders., sexual dysfunction, vertigo, oedema, muscle weakness, palpitations……etc etc
PREGNANCY – Extrapyramidal effects and withdrawal syndrome, agitation, hypertonia, tremor, drowsiness, feeding problems and respiratory distress
FOR PALIPERIDONE USE ONLY IF POTENTIAL BENEFIT OUTWEIGHTS RISK = toxicity in animal studies. YES THERE ARE SUBSTANTIAL RISKS AND THE DRUG IS BEING PRESCRIBED AGAINST COTRAINDICATIONS
Manufacturer advises to consider long acting nature of formulation – Palperidone is detected in plasma up to 18 months after a single dose.
CHILDREN – regular clinical monitoring of endocrine function should be considered when children are taking an antipsychotic drug known to increase prolactin levels. This includes measuring weight and height, assessing sexual maturation and monitoring menstrual function.
Risk of relapse if medication stopped after 1 – 2 years. Withdrawal should always be gradual and closely monitored to avoid risk of acute withdrawal syndromes or rapid relapse. Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse.
- Dr Neil Sarkar is RC on Ruby Ward
- Dr Helen Moorey is RC on Suffolk Ward Chase Farm Hospital
The “care” is being provided by local area ENFIELD at a cost of circa £450 a day to stay on a NHS ward (or it may well be more as this is a PICU ward) or £900 a day on a private ward. The care is not to assess Elizabeth’s underlying physical health conditions but purely put her on a power dangerous depot injection and try to justify themselves for doing that. I had begged that she be sent to a brain trauma injury ward for assessment but ENFIELD MENTAL HEALTH have chosen to ignore the physical health of my daughter. How many more I wonder have been affected in this way? So they use facilities like Ruby Ward but they are the ones dictating behind the scenes as to the care as this is being provided by ENFIELD.
“Dear Ms Bevis,
Thank you for your e-mail.
I have read it carefully and appreciate you sending us information which you believe will help in your daughter’s care.
I cannot fully comment on all the points you raised, but will certainly investigate as much as possible. I will try to obtain some of these reports, especially the opinion from the National Psychosis Unit. I have all their files of shocking content.
The Opinion of “Treatment Resistance” identified by Royal Bethlem has been dropped by ENFIELD despite the P450 liver enzyme test results. The Opinion on diagnosis by several other doctors differs but I feel the correct opinion is Complex PTSD by Dr Bob Johnson and Selyes Generalised Adaptational Syndrome which has been completely ignored. She has gone back to being a young teenager. Elizabeth was severely abused under Moti Villa scheme in the community going back to 2010. She has a Learning Disability; she has a brain injury noted by Dr Diane Caine in 2009 which has been ignored. You cannot treat a brain injury with antipsychotic drugs. Metformine was prescribed off label at Royal Bethlem – only an Endocrinologist should prescribe this off label. Tachycardia was contracted on titration of Clozapine.
- We do not have Elizabeth’s consent to discuss her case with you and we are not allowed to share information about her with you. However, we can receive information from you. Elizabeth has given her consent so now you can discuss and share.
Elizabeth is likely to only be under our care on Ruby Ward Women’s PICU for a short period of time until any aggression and risk has been reduced. This is on average 2 weeks, but can be even less. Noted. However just look at the side effects of this drug agitation is noted as a side effect and skin irritation SO A DRUG LIKE THIS CAN ACTUALLY CAUSE AGITATION – HOW DOES THIS WORK THEN???
However I thought her time spent with you was to assess her properly. She needs to be assessed by a Endocrinologist; Neurologist.
When I spoke to my daughter on the ward phone yesterday she sounded very distressed about these injections. She was complaining of chest pains yesterday.
Please confirm and also why you have not referred her to the Psychodynamic Psychotherapist for assessment.
Overall responsibility for her care will be under ENFIELD mental health services thereafter and we need to work in close conjunction with them throughout. How interesting – they have chosen to ignore “Anterior Region Medial Temporal Comprise back in a 2009 report.
Regardless of Enfield, you have duty of care for my daughter and better resources at your hospital than Enfield.
Enfield have neglected her physical health leading to her going downhill time and time again. It was suggested at a previous tribunal that full hormone checks be done.. Neither referral to Endocrinologist or for MRI scan has been made.
Physical health should be paramount. I am referring this fact to my local MP and The Rt Hon Kier Starmar. My daughter has suffered injury because her physical health is being ignored.
We therefore would not be making any major changes to her overall care, but just trying to stabilise her in the short term and then referring her back to Enfield services. I am very disappointed to hear this because you have something good on your site ie psychodynamic psychotherapy. It would seem…
- I will pass on your e-mails with Enfield services, so they are also aware of your concerns and opinion, as your daughter’s long term care will be with them. Then perhaps Elizabeth will only be treated fairly and not neglected in terms of her physical health if she moves away from Enfield.
I hope you can understand our position. I do not understand how any Doctor can ignore underlying physical health conditions documented in reports no matter what because every Doctor should have a duty of care. The matter of mental health being on par with physical health therefore needs to be addressed.
The other reason I object to depot injections is the fact that Elizabeth is “treatment resistant” and a poor/non metaboliser.
Prolongation of the QT Interval can cause heart arrhythmia to someone who has low blood potassium and at risk of a heart attack.
So what level of Potassium is the result?
What are the magnesium levels also and the prolactin levels? – magnesium also recorded as “low”
My daughter should not be having this drug because it is contra indicated and i am particularly concerned about the prolongation of the QT Interval. Throughout the files Elizabeth is recorded as having an irregular heart arrhythmia. Also who exactly is responsible for the very specialised administration of this expensive drug. Risperidone was previously found to be allergic to but this has been ignored by ENFIELD? so Palperidone – metabolite highly dangerous to someone low in Potassium – prolonged QT interval – risk of heart attack. WHY IS THIS DRUG BEING PRESCRIBED ENFIELD especially in light of the following contraindications noted in bold.
Who should not take Paliperidone Palmitate Syringe?
The following conditions are contraindicated with this drug. Check with your physician if you have any of the following: Yes Elizabeth does have as highlighted in yellow.
- breast cancer
- diabetes – not sure – has PCOS and is insulin resistant – private Endocrinology tests
- a high prolactin level
- excessive fat in the blood
- low amount of magnesium in the blood
- low amount of potassium in the blood
- very low levels of granulocytes
- a type of white blood cell
- low levels of white blood cells
- low levels of a type of white blood cell called neutrophils
- suicidal thoughts
- a type of movement disorder called parkinsonism
- tardive dyskinesia
- a disorder characterized by involuntary movements of the face
- mouth and tongue – seen that on Clozapine
- neuroleptic malignant syndrome
- a reaction characterized by fever
- muscle rigidity and confusion
- a low seizure threshold
- a heart attack
- a type of chest pain
- torsades de pointes
- a type of abnormal heart rhythm – (has suffered palpitations and tachycardia recorded in files of the Bethlem and Mews Score 3 critical)
- chronic heart failure
- abnormal EKG with QT changes from birth Not sure – were complications at birth
- a disorder of the blood vessels of the brain
- orthostatic hypotension
- a form of low blood pressure
- compression of the esophagus
- a prolonged erection of the penis
- weight gain
- susceptible to breathing fluid into lungs
- decreased blood volume
- problems with food passing through the esophagus
- metabolic syndrome x
- dementia in an elderly person I have had extensive private tests done genetic tests done that point to interesting results
- diffuse Lewy body disease
- cataract surgery Has complained of pain to eyes and index finger/joint pains like Arthrytis
- floppy iris during eye surgery
- abnormal muscle movements – yes on Clozapine
- chronic kidney disease stage 2 (mild)
- chronic kidney disease stage 3A (moderate) – thought I had seen this in the files
- chronic kidney disease stage 3B (moderate)
- chronic kidney disease stage 4 (severe)
Allergies: Used to have chronic asthma as a child
- Risperidone Analogues
I look forward to hearing from you about my main concerns on contraindications because of Xeplion (Palperidone).